原发性头汗症的外科手术治疗

The surgical treatment of primary craniofacial hyperidrosis

目的：比较胸腔镜下第二肋骨表面交感神经链（ R2）切断术及第三肋骨表面交感神经链（R3）切断术治疗原发性头汗症效果。方法65例原发性头汗症患者，实施R2节段手术23例（ A组），R3节段42例（ B组），通过随访术后头面部出汗程度，代偿性多汗，患者满意程度等评估两种术式优缺点。结果随访61例患者，A组19例患者头面部多汗缓解，2例单侧缓解。B组35例缓解，2例单侧缓解，3例复发，两组之间头面部多汗缓解率差异无统计学意义。A组（95.2%）代偿性多汗发生率与B组（95%）相似，两组之间差异无统计学意义，但重度代偿性多汗A组明显高于B组（p〈0.05）。两组术后患者满意度A组为90.4%，B组为87.5%，两组之间差异无统计学意义。结论 R3交感神经切断术治疗原发性头汗症安全、有效，并可减少重度代偿性多汗的发生。

Objective To compare the results of thoracoscopic R2 sympathectomy and R3 sympa-thectomy in treating primary craniofacial hyperhidrosis. Methods R2 sympathectomy and R3 sympathec-tomy were performed in 65 patients from May 2008 to March 2014. There were 23 patients undergoing R2 sympathectomy（ group A）,and 42 undergoing R3 sympathectomy（ group B）. The situation of craniofacial sweating,the grade of compensatory sweating and the rate of satisfaction were retrospectively analyzed. Re-sults Sixty-one patients were followed up. In group A,19 cases of craniofacial hyperhidrosis were com-pletely alleviated,and 2 cases were unilaterally alleviated. In group B,35 cases were completely alleviated, 2 cases were unilaterally alleviated,and 3 cases had recurrent moderate sweating. The rate of compensatory sweating in group A（95. 2%）was similar with group B（95%）（p〉0. 05）;and the rate of severe com-pensatory sweating was lower in group B（p〈0. 05）. The rate of satisfaction in group A and group B was 90. 4%,87. 5%,respectively,and there was no statistically significant difference. Conclusion Thoraco-scopic R3 sympathectomy is safe and effective for treatment of craniofacial hyperhidrosis and reduces the rate of severe compensatory sweating.